Anxiety Disorders Flashcards
What are the 3 models of stress?
Models of Stress;
- Biomechanical “Engineering”
- Medicophysiological
- Psychological (Transactional)
What is the Engineering Model of stress?
The idea that stressors fill up the bucket with water and relievers reduce the volume of water so it all doesnt boil over.
What is the Medicophysiological Model of Stress?
The idea that stressors cause the pituitary to release ACTH which triggers the adrenal gland to produce Stress Hormones (corticoids, adrenaline and noradrenaline) to trigger fight or flight
What is the Psychological (transactionsal) Model of Stress?
An individual’s reaction to stress will depend on a balance between their cognitive processing of any perceived threat and their perceived ability to cope.
Coping is either;
- Problem focussed
- Emotion focussed
When does stress become anxiety?
When a normal stress response occurs at an abnormal time or to an abnormal degree
What are the Autonomic Symptoms seen in Anxiety/Panic Attack?
Gastrointestinal;
- Dry Mouth
- Swallowing difficulties
- Dyspepsia, nausea and wind
- Frequent loose motions
Respiratory;
- Tight chest, difficulty inhaling
Cardiovascular;
- Palpitations/Missed beats
- Chest pain
Genitourinary;
- Frequency/urgency of
micturition
- Amenorrhoea/ Dysmenorrhoea
- Erectile failure
CNS;
- Dizziness and sweating
What are some Psychological symptoms of anxiety?
Psychological Symptoms
- Fearful Anticipation
- Irritability
- Sensitivity to noise
- Poor concentration
- Worrying Thoughts
What are some other associated symptoms with anxiety ?
Muscle Tension;
- Tremor
- Headache
- Muscle pain
Hyperventilation;
- Causing CO2 deficit hypocapnia
- Numbness and tingling in extremities may lead to carpopedal spasm
- Breathlessness
Sleep Disturbance;
- Initial insomnia
- Frequent waking
- Nightmares and night terrors
What do we use to classify anxiety disorders?
ICD-11
What is the difference between Phobic Anxiety Disorders and General Anxiety Disorders?
Both these sets of disorders have same core anxiety symptoms but they EITHER occur in particular circumstances (difference is when it occurs):
PHOBIAS;
- Agoraphobia
- Social phobia
- Specific (Isolated) Phobias
OR Occur persistently
- GENERALISED ANXIETY DISORDER (GAD)
WHat are the features of Generalised Anxiety Disorder?
Persistent (several months) symptoms not confined to a situation or object.
All the symptoms of human anxiety mentioned earlier can occur;
- Psychological arousal
- Autonomic Arousal
- Muscle Tension
- Hyperventilation
- Sleep Disturbance
What are some differential diagnoses for Anxiety Disorders?
Psychiatric Conditions;
- Depression
- Schizophrenia
- Dementia
- Substance Misuse
Physical Conditions;
- Thyrotoxicosis
- Phaeochromocytoma (tumour secreting adrenalinę)
- Hypoglycaemia
- Asthma and or Arrhythmias
What is the Epidemiology of Generalised Anxiety Disorder (GAD)?
Anxiety disorders are the world’s most common mental disorders, affecting 301 million people in 2019.
More women are affected by anxiety disorders than men.
Symptoms of anxiety often have onset during childhood or adolescence.
Approximately 1 in 4 people with anxiety disorders receive treatment for this condition.
What is the difference between anxiety and anxiety disorders?
Remember, there is no clear line between “normal” anxiety and anxiety disorders. They differ in the extent of symptoms and duration.
“In general terms, GAD for instance is caused by a stressor acting on a personality predisposed to the disorder by a combination of genetic
factors and environmental influences in childhood.”.
What are some ways to manage Generalised Anxiety Disorder (GAD)?
Counselling
- Clear Plan of Management
- Explanation and education
- Advice regarding caffeine, alcohol, exercise, etc.
Relaxation training
- Group or individual
- DVDs, tapes or clinician-led
Medication
- Sedatives have high-risk dependency
- Antidepressants SSRI or TCA
Cognitive Behavioural Therapy
What are Phobic Anxiety Disorders ?
Key Features of Phobic Anxiety Disorders;
- Same core features as GAD
- ONLY in specific circumstances
- Person behaves to avoid these circumstances “phobic avoidance”.
The sufferer also experiences anxiety if there is a perceived threat of encountering the feared object or situation, “anticipatory anxiety.”
What are some Phobic Anxiety Disorders?
- Agoraphobia (fear or worry of going outside)
- Claustrophobia (fear of small spaces, usually traumatic)
- Ophidiophobia (fear of snakes)
- Arachnophobia (fear of spiders)
- Trypophobia (fear of holes)
- Submechanophobia (fear of underwater man-made objects)
*Don’t need to know all of these
What are 3 clinically important syndromes of Phobic Anxiety Disorder?
- Specific Phobias (CBT and exposure therapy building up exposure to it - useful in OCD) are treatments)
- Social Phobia
- Agoraphobia (fear or worry of going outside)
What is Social Phobia?
Social Phobia as example Phobic Disorder;
Inappropriate anxiety in situations where person feels observed or
could be criticised (ICD-II thinks about fleeing being difficult)
- Restaurants
- Shops or any queues
- Public speaking
Symptoms are any of the anxiety clusters mentioned above, but blushing and tremors predominate
What is the treatment for Social Phobia ?
B is behaviours - avoidance, alcohol.
About breaking the cycle and being aware of it.
Simplified way of thinking about it
What Obsessive Compulsive Disorder (OCD)?
Compulsive Acts or Rituals (ritualistic behaviours to get rid of thoughts)
- Stereotypical behaviours repeated again and again
- Not enjoyable
- Not helpful, i.e. do not result in useful activity
Often viewed by the sufferer as
- preventing some harm to self or others; “magical undoing.”
- Viewed as pointless and resisted with key anxiety symptoms accompanying resistance
*Obsessive thoughts something will happen and compulsion to get rid of it
What is the prevalence of OCD and the theory of how its developed?
Overall one year prevalence is 2%
Equally affects men and women
Aetiological Theory
- Genetic e.g. gene coding for 5HT receptors
- 5 HT function abnormalities
How do we manage OCD?
Good history and MSE exclude treatable depressive illness.
General measures;
- Education and explanation
- Involve partner/family
Serotonergic Drugs;
- SSRI, eg Fluoxetine (Gold Standard)
- Clomipramine
(Often need higher doses than we usually prescribe of SSRI)
Cognitive Behavioural Therapy (CBT);
- Exposure and response prevention
- Examination of evidence to weaken convictions
(Nothing bad will happen if you don’t do the thing your worried about)
Psychosurgery;
(More common for OCD than depression)
What was PSTD initially called and thought to be?
Shell Shocked
- First used in 1915
- Not well understood
- Thought related to concussion or
damage to the brain from artillery.
- Often disregarded and seen as cowardice by the military leadership
What are the 3 key components to a PTSD reaction?
1). Hyperarousal (Always continuously aware)
2). Re-experiencing phenomena (Flashbacks, see images, smell scene as if they’re back there)
3). Avoidance of reminders (Where some of the limitations are in not being able to do things)
What is PTSD and how can it occur?
Post Traumatic Stress Disorder (PTSD)
“Delayed and or protracted reaction to a stressor of exceptional
severity” (would distress anyone)
Triggers;
- Combat
- Natural or human-caused disaster
- Rape
- Assault
- Torture
- Witnessing any of the above
What are features of Hyperarousal?
- Persistent anxiety
- Irritability
- Insomnia
- Poor concentration
What are the features of the Re-experiencing phenomena?
- Intense intrusive images
- Flashbacks when awake
- Nightmares during sleep
What are the features of Avoidance?
- Emotional numbness
- Cue avoidance
- Recall difficulties
- Diminishes interests
Alcohol in PTSD is a big one a lot of people turn to in a way to numb themselves and repress thoughts
What is the Epidemiology of PTSD?
- Much of the population data comes from the USA
- Variable cultural factors and exposure to disaster lead to variable prevalence, 1-4% one-year prevalence
- Women sufferers out number men 2 to 1 in USA
What are the causes of PTSD?
Main cause - Nature of stressor
A life-threatening and degree of exposure generally confers greater risk however
Vulnerability factors;
- Mood disorder
- Previous trauma especially as a child
- Lack of social support
- Female
- Protective factors (examples)
- Higher education and social group
- Good paternal relationship
Susceptibility partly genetic
How is PTSD managed?
- Survivors of disasters screened at one month
- Mild symptoms “watchful waiting” and review further month
- Trauma-focused CBT if more severe symptoms
- Eye Movement Desensitisation and Reprocessing (In moment adrenaline is going and not processing information and what is going on. Partly to do with how memories are made with rapid eye movement when sleeping etc)
- Risk of dependence with any sedatives but patient may prefer medication SSRI or TCA (Can worsen if given too soon)
*Avoid alcohol and speaking to people helps
*Mirtazapine helps with flashbacks and is a sedative helping to sleep
NICE guidance www.nice.org.uk
